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Following ACA Implementation, Cancer Survivors Still Experienced More Barriers to Accessing, Affording Healthcare

Jaime Rosenberg
Despite having higher rates of insurance coverage and more education, cancer survivors were more likely to report difficulties accessing and affording care than adults with no reported history of cancer.
Despite higher rates of insurance coverage and more education, cancer survivors still experience difficulties accessing and paying for healthcare compared with individuals without cancer, according to a new study published in JAMA Oncology.

Cancer survivors’ unique long-term healthcare needs also come with high risk for experiencing financial burden related to high costs of their care. According to the authors of the study, “Growing evidence demonstrates that patients with cancer experience substantial economic hardship related to their care, yet barriers to accessing and affording care experienced by cancer survivors remain understudied.”

With previous research on financial concerns as a barrier to care having been conducted prior to the Affordable Care Act coupled with rising health costs, researchers conducted an updated analysis of cancer survivors’ ability to access and afford healthcare using cross-sectional data from serial samples of the National Health Interview Survey from 2010 to 2016.

The survey asked participants if they had ever been told by a healthcare professional that they had cancer or a malignant abnormality. If they answered yes, they gave the type of cancer and the age of diagnosis. Questions also inquired about a patient’s ability to afford different types of care and services in the previous 12 months, which included prescription medication, mental health care, dental care, eyeglasses, specialist care, and follow-up care.

The study included 15,182 cancer survivors and 15,182 control respondents (adults with no reported history of cancer). Cancer survivors were more likely to be insured (94.8% vs 92.2%), have government-sponsored insurance (44.3% vs 38.8%), and have paid sick leave (59.4% vs 57.1%). They were also less likely to have less than a high school education (13.6% vs 16.6%).

Cancer survivors were more likely to experience difficulties accessing care, reporting problems such as delayed medical care (odds ratio [OR], 1.38; 95% CI, 1.16-1.63; P < .001) and needing but not getting medical care (OR, 1.76; 95% CI, 1.45-2.12;  < .001). The cohort was also more likely to report being unable to afford prescription medication (OR, 1.77; 95% CI, 1.46-2.14; P  < .001) and being unable to afford at least 1 of the 6 services (OR, 1.46; 95% CI, 1.27-1.68;  < .001).

However, the proportion of cancer survivors reporting difficulties to healthcare accessibility and affordability decreased each year during the time period. The proportion of survivors reporting delayed medical care decreased by 0.47 percentage points per year, and the proportion of those needing and not getting medical care decreased by 0.35 percentage points each year. The proportion of survivors reporting being unable to afford prescription medication decreased by 0.66 percentage points per year, and the proportion of those unable to afford at least 1 of the 6 services decreased by 0.51 percentage points each year.

In both cohorts, being unmarried, having no paid sick leave, lower income, and not having government-sponsored or private insurance were associated with healthcare accessibility and affordability issues. Being female was associated with healthcare affordability issues in both cohorts.

“With the growing number of cancer survivors and the rising costs of healthcare in the United States, further efforts to enhance access to affordable healthcare should build on our findings and focus on improving our understanding of specific financial barriers, consequences of these barriers, and opportunities to screen for and address patients’ financial burden and barriers to care,” concluded the authors.


Nipp R, Shui A, Perez G, et al. Patterns in healthcare access and affordability among cancer survivors during implementation of the Affordable Care Act [published online March 29, 2018]. JAMA Oncol. doi: 10.1001/jamaoncol.2018.0097.

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